Should we pass on the clever pills?

If we can drink coffee to improve our concentration, why not take cleverer drugs to make us cleverer? At our discussion event about cognitive enhancement in February, Lydia Harriss was on hand to consider some thorny issues.

Would you take a pill to help you pass an exam?

“Definitely not!” I hear at least some of you say, bristling with indignation at the mere suggestion. That would be cheating, like an athlete taking performance-enhancing drugs before a competition. But are there occasions when using cognitive-enhancing drugs – which improve mental functions such as memory, attention and information processing – would be acceptable, or even desirable? A lively discussion at ‘The Clever Pill’, in February’s series of events on neuroethics at Wellcome Collection, made me think that there might.

What if cognitive-enhancing drugs (let’s call them CEDs) could be used to restore cognitive function in people who have lost some of their mental ability through injury or illness? Arguing against their use on purely ethical grounds, I think, would be difficult. Cries of ‘unfair advantage’ would seem churlish if a drug had the potential to improve a person’s quality of life, particularly if it were compensating for the loss of an ability that they’d originally had.

How about non-therapeutic situations? Are there some professionals who we should allow to use CEDs under certain, tightly regulated, conditions? Panellist Dr James Rowe, Clinical Neurologist and Wellcome Trust Senior Research Fellow, suggested that surgeons working on nightshifts could be good candidates. Perhaps they should have the option of taking CEDs to improve their attention and judgement for emergency night-time operations, when patients’ lives depend on accuracy and clear thinking but surgeons are likely to be more tired. That could be a win–win situation: the patient benefits from an operation that is performed as well as it can be, and the surgeon is elevated to a level of heightened skill.

But would it really be that simple? It would be difficult to claim that surgeons would have an ‘unfair advantage’ in this scenario, given that patients would be the main beneficiaries. However, there are other, more sinister, potential consequences… can you hear those slithering noises? They’re coming from a shiny can labelled ‘side-effects’. I’m afraid to lift the lid, as I suspect there are way more worms in there than I can deal with, but let’s be brave and take a tiny peek.

Side-effects are always a consideration where drugs are concerned. Researchers can do clinical trials to investigate the effects of a drug over a few years, but it becomes much harder to look at how humans respond to it over decades or a lifetime. So, realistically, there’s probably always some possibility, no matter how remote, of a person having an unintended reaction to a drug.

When drugs are taken as medical treatment, the potential benefits (which are often substantial) can be weighed against the possibility of adverse side-effects. But is it fair to allow our hard-working surgeons, who are running themselves ragged trying to save lives, to accept the risks associated with CEDs if there’s no personal benefit to their own health?

We could leave it up to individual surgeons to make a personal decision (assuming that the CEDs in question have passed the efficacy and safety tests required for new drugs). Surely professionals should have the freedom to decide whether CEDs are a useful tool that can help them in their work?

However, there’s another possible consequence rearing out of the increasingly murky waters of this debate – coercion. If more and more surgeons take CEDs, it seems likely that some individuals who would otherwise not want to take them could feel compelled to, under the weight of social expectation or the fear of falling behind in their careers.

When the debate swivels around to the idea of making CEDs freely available to everyone, the issues become even more complex. Perhaps CEDs could help us to more fully achieve our potential? They could enable us to be more productive, creative and clever.

Panellist and Senior Research Fellow at the Oxford Martin School’s Institute for Science and Ethics, Dr Bennet Foddy, pointed out that a huge number of cognitive enhancers are already in wide use throughout society. They include caffeine, carbohydrate-rich food, exercise and sleep. He suggested that there isn’t a moral distinction between taking a drug and using an alternative form of cognitive enhancement.

That may be true, but it seems to me that most of these other alternatives are widely available. I could choose to go for a run after work to boost my mental processes. If I decide that I’d rather spend the evening crashed out on the couch watching TV, then I’ve chosen to miss out. But if a wonder pill did exist that could significantly boost mental performance, it would probably cost money, and that brings with it the prospect of inequality. Would we find ourselves with an even more profoundly divided society, with intellectual disadvantage compounding existing economic privations? Without a crystal ball, it’s difficult to tell, but I wasn’t the only person in the audience who thought that it might.

I was intrigued to hear Professor Simon Wessely, Professor of Psychological Medicine at King’s College London, give his views on currently available CEDs. It felt like a sharp reality check. He said that the cognitive-enhancing effects provided by today’s drugs are very modest, and that even the longest-lasting effects wear off within about 12 weeks.

According to Dr Rowe, research suggests that CEDs tend to have the greatest effect on people with a below average IQ or those who have a temporary loss of cognitive ability – for example, through tiredness. This could mean that some of the people most tempted to take enhancers, such as high-performing students under pressure to succeed, may be less likely to benefit from them. Dr Rowe seemed to succinctly sum up the situation when he said that the benefits from a good night’s sleep, social networking and exercise will outstrip those from any of the drugs currently available.

Significant and lasting cognitive enhancement through drugs seems to be well beyond the reach of current research. After hearing the knotty issues surrounding CEDs, I’m rather relieved to hear that we don’t have the ability to lever open this particular Pandora’s Box just yet. However, it’s clear that there’s much to consider if one day we do.

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